Mobile health app improves heart failure medication use, dosing after hospitalization

A mobile health application improved the use and dosing of recommended medications for patients with heart failure, according to a new study.

The ENGAGE-HF trial, led by University of Michigan researchers, evaluated whether a mobile application could help clinicians improve patients’ medication regimens during the critical 90 days after hospitalization for heart failure. 

The application prompts patients to enter health measurements, including blood pressure, heart rate and weight and track their symptoms. It also helps patients see whether their heart failure medications are at recommended levels for them based on their clinical data.  

Clinicians had access to a dashboard showing patients’ data from the app, which alerted them to changes in health status between and before clinic visits. 

Mobile health intervention

Researchers randomly assigned half of the participants to use the mobile intervention, while the other half received usual heart failure care.

After 90 days, the intervention group had a medication optimization score of 83.7%, compared with 74% for the usual care group — a difference of nearly 10 percentage points.

The research was presented as late breaking science at the 2026 American Heart Association Scientific Sessions and published in Circulation: Heart Failure, a peer-reviewed journal of the AHA.

“Our results show promise for a mobile health intervention that may improve the initiation and dosing of guideline-directed medical therapy,” said Michael P. Dorsch, PharmD, M.S., lead author on the study and Lynda S Welage Collegiate Professor of Pharmacy at U-M. 

“The period after a patient with heart failure leaves the hospital is critical for managing the condition. If medications are not initiated and adjusted appropriately, patients may face a higher risk of being readmitted to the hospital or experiencing other serious complications.” 

3 million Americans

More than 3 million Americans have heart failure with reduced ejection fraction, or HFrEF, a condition in which the heart’s left ventricle does not sufficiently pump blood to the rest of the body. 

Treatment guidelines for HFrEF recommend four types of medication classes: beta-blockers, renin–angiotensin system inhibitors, sodium-glucose cotransporter 2 (SGLT) inhibitors and mineralocorticoid receptor antagonists (MRAs). 

When prescribed at appropriate doses, the medications can significantly reduce the risk of hospitalization and death. However, clinicians often start these medications at low doses and gradually increase toward target doses.

Fewer than one in five patients leave the hospital taking medications from all four classes, and fewer than 20% of patients have these lifesaving therapies adjusted during the following year.

Remote monitoring

In the ENGAGE-HF trial, the mobile application allowed clinicians to remotely monitor patients’ health and symptoms. It also alerted clinicians when a patient might be eligible to start a medication or have a dose adjusted.

After 90 days, the intervention group showed larger increases in the use of MRAs and SGLT2 inhibitors than the usual-care group. Patients receiving the intervention also had greater increases in reaching target doses of beta-blockers and angiotensin receptor-neprilysin inhibitors.

Patient-reported symptom and physical-limitation scores were slightly higher in the mobile intervention group, but the difference was not statistically significant. 

“Adjusting heart failure medications can be difficult when the process depends on frequent in-person visits,” said co-senior author Jessica R. Golbus, M.D., M.S., heart failure cardiologist at the U-M Health Frankel Cardiovascular Center and Assistant Professor of Internal Medicine-Cardiology at U-M Medical School.

“It’s promising to see that an intervention has potential to overcome some of those barriers and help clinicians make medication decisions more efficiently.”

In a future trial, researchers plan to evaluate whether using the mobile intervention leads to better outcomes for heart failure patients. 

Paper cited: "A Multicenter Randomized Controlled Trial of a Digital Health Intervention for Medication Optimization in Heart Failure: The ENGAGE-HF Trial Outcomes," Circulation: Heart Failure. DOI: 10.1161/CIRCHEARTFAILURE.126.015192

Additional authors: Brad Trumpower, M.S., Sabah Ganai, M.P.H., Tanima Basu, M.S., Evan Luff, M.S., Margaret O’Neill,  Brahmajee K. Nallamothu, M.D., M.P.H. and Alexander T. Sandhu, M.D., all of University of Michigan, see remaining authors online.

Funding/disclosures: The American Heart Association funded this research through the Strategic Focused Research Network for Health Technology and Innovation.

The content is solely the authors' responsibility and does not represent the official views of the AHA.